Most primary care doctors are still waiting for that Medicaid pay raise that was scheduled to begin in January under the Affordable Care Act, but a federal official says the government has now approved applications from 48 states to begin paying the higher rates. A spokeswoman for the Centers for Medicare & Medicaid Services says with those approvals in hand, every state but California and Alaska is expected to implement the pay raise this summer. Under the law, Medicaid fees for primary care would be increased for two years to the same amount paid under Medicare. The change means an average 73 percent pay increase nationally, according to a 2012 study by the Kaiser Family Foundation.